OVERVIEW
We are seeking a visionary leader in managed care pharmacy to drive the strategic design, execution, and oversight of all clinical and quality programs within the Pharmacy Department of our renowned health insurance client company. This executive role shapes the organization’s pharmacy clinical strategy, ensuring alignment with regulatory requirements, population health goals, and enterprise‑wide objectives.
The VP serves as the enterprise pharmacy clinical expert, overseeing high‑impact programs such as MTM, Drug Management Programs, CMS STARS initiatives, pharmacy utilization strategies, academic education, member education programs, and regulatory management of grievances and appeals. This role also leads the Pharmacy Account Management function, strengthens cross‑functional collaboration, and represents the department in executive, regulatory, and client‑facing forums.
KEY RESPONSABILITES
Develop and lead comprehensive work plans for Clinical Services, Pharmacy Utilization, and Account Management, ensuring full compliance with federal and local regulations.
Direct the design, implementation, and continuous improvement of pharmacy clinical programs aligned with organizational goals, quality standards, and member needs.
Oversee delegated provider functions related to MTMP, Integrated Diabetes Programs, Specialty Pharmacy Interventions, DMP/DPP, and STARS measures.
Ensure all clinical and quality programs meet CMS, NCQA, HEDIS, STARS, and other applicable regulatory requirements.
Serve as the primary clinical liaison between Pharmacy and Clinical Affairs, ensuring seamless integration of pharmacy services into broader clinical initiatives.
Lead the Pharmacy Account Management team, ensuring exceptional client support, operational efficiency, and alignment with business strategy.
Oversee all pharmacy communications, including member‑facing materials and regulatory documents, ensuring accuracy, timeliness, and brand compliance.
Represent the Pharmacy Department in client meetings, regulatory interactions, and internal executive forums, delivering strategic presentations and guidance.
Contribute to departmental budgeting and ensure all clinical and quality initiatives are executed within budget while maintaining operational excellence.
CANDIDATE'S PROFILE
Doctor of Pharmacy (PharmD) or equivalent degree required.
Minimum 9 years of progressive leadership experience in managed care pharmacy, clinical program development, or pharmacy quality management.
At least 4 years of direct supervisory experience.
Proven success applying quality and performance metrics.
Active pharmacist license and registration in Puerto Rico.
Membership in the Puerto Rico Pharmacists Association.
Deep expertise in CMS, NCQA, HEDIS, STARS, and federal/state health regulations.
Strong command of pharmacy benefit systems, clinical data analytics, and population health strategies.
Spanish – Advanced
English – Advanced
Compensation:
TPIS is an Equal Opportunity Employer (EEO Employer / Affirmative Action for Females / Disabled / Veterans). We comply with all Federal, State and Local laws regarding nondiscrimination.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
TPIS is a company operating in the technology and services sector.